Part B Insider (Multispecialty) Coding Alert

Physician Notes:

Feds Open MIPS 2021 Targeted Review Window

Published on Mon Sep 19, 2022

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If your MIPS data, final score, or payment adjustment for the 2021 performance year doesn’t match up with your files, now is the time to request a Targeted Review before the window closes.

Then: The Centers for Medicare & Medicaid Services (CMS) recently updated Merit-Based Incentive Payment System (MIPS)-eligible clinician accounts with 2021 performance year final scores for preview. The preview option is new this year and is part of CMS’ efforts to offer providers more transparency about payment adjustments and MIPS final scores.

Remember: “For MIPS-eligible clinicians, your 2021 final score determines the payment adjustment you’ll receive in 2023; a positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished in 2023,” reminds CMS in an Aug. 22 alert.

Now: CMS announced that the MIPS 2021 Targeted Review period has begun, reminding MIPS-eligible clinicians that their 2021 final scores determine their 2023 payments, the alert says. Plus, those 2023 MIPS payments reflect “a positive, negative, or neutral payment adjustment [which] will be applied to the Medicare paid amount for covered professional services furnished in 2023,” CMS explains.

CMS allows MIPS-ECs to request a Targeted Review of their data when they discover an error in payment adjustment calculations. Past reasons for requests have included MIPS eligibility and status errors; incorrect National Provider Identifier or Taxpayer Identification Number; or the reweighting of the wrong performance category, according to the agency.

MIPS-ECs, groups, virtual groups, and APM entities can request Targeted Reviews via the Quality Payment Program portal through Oct. 21.

Resource: Review MIPS 2021 data and make review requests at https://qpp.cms.gov/login.